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i" SAN JOAQUIN COUNTY <br /> zx. A EN'S RONMENTAL HEALTH DEPARTME <br /> :z <br /> 6'00 E.*111 �„-mgt-� giber A-venue, m Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��1FORa <br /> VECTOR CONTROL INSPECTION FORM <br /> POULTRY RANCH DBA ���w jT C ra p INSPECT)ON D T/E' <br /> Structure Operation Water Well 'L.si. ke d t� a C�^'t, le 6 V� �/ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS A REINSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection ! . �ad <br /> Structure Operation Manure Management OWNER/OPERATOR // HO <br /> ❑ ❑ 3. Spreading and Disking a-1 j afw� t:'� Ile (?� ��� <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE ] PROGRAM EL T RE RD ID <br /> 11 El 5. Lagooning Akw & 1 L4. -/q <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank A' ,. q <br /> 11 9. Removal from Premises 1 �t t' A t f <br /> -tvi en <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI �� Y at <br /> ❑ ❑ 11. Fannia FI �y <br /> ❑ ❑ 12. Larvae �� r M _V~S a <br /> ❑ ❑ 13. Pupae /y,, <br /> o <br /> 11 14. Adult P /a Ch � fov, W <br /> ❑ ❑ 15. Light Population jj <br /> r ) <br /> 11 El 16. Moderate Population F ✓ I( ✓� �'l <br /> ❑ ❑ 17. Heavy Population t r <br /> Structure Operation Feeding/Water i r� t \ Wr/t - ©•t„��(iL.•�y�{L(� <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> ❑ ❑ 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 1 21. Floors l <br /> ❑ ❑ 22. Walls/Ceilings a ' �-7m J r mss- S r orris <br /> ❑ ❑ 23. Cleaning Frequency <br /> KENNEL Oil `5f.S au� 0111A,m CLP� <br /> Structure operation Water Well r <br /> ❑ ❑ 1. Well Construction <br /> ❑ ❑ 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Properly Graded to <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable n <br /> 11 6. Covin 11 <br /> r <br /> 1 ❑ 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> ❑ ❑ 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> ❑ ❑ 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises 15671,41WAI I 0&x n,l <br /> EHD 40-06 6/30/2005 age it-Of <br />